Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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At Liv Hospital, we treat pulmonary embolism based on how serious the symptoms are and the risk of early death. Our main goals are to keep the patient stable, stop the clot from growing, prevent new clots, and, if needed, remove or dissolve the clot. Treatments can range from pills for stable patients to emergency surgery for those in shock. Our team of lung, heart, and radiology specialists works together to choose the best plan for each patient.
Anticoagulants, or blood thinners, are the cornerstone of treatment for the vast majority of PE cases. They do not dissolve the clot but prevent it from growing and allow the body’s natural fibrinolytic system to break it down over time.
Vitamin K Antagonists: Warfarin is the traditional oral blood thinner. It requires careful monitoring of the INR (International Normalized Ratio) and is affected by diet (vitamin K intake) and many other medications. It is reserved for patients with severe renal failure, antiphospholipid syndrome, or mechanical heart valves.
Thrombolytics, or “clot busters,” are potent drugs that actively dissolve blood clots.
Indications: The decision to use systemic thrombolysis is a careful balance of life-saving benefit versus bleeding risk. It rapidly reduces pulmonary artery pressure and improves proper heart function in critically ill patients.
For patients who are at high risk for bleeding or have submassive PE with significant heart strain, minimally invasive catheter procedures offer an alternative.
In dire emergencies where thrombolysis fails or is contraindicated, open-heart surgery may be necessary.
Context: This is a high-risk procedure typically performed in specialized centers for patients with massive PE who are in cardiac arrest or shock and are not candidates for other therapies. It can be life-saving in catastrophic situations.
When anticoagulation is dangerous or ineffective, a mechanical barrier can be placed.
Indications: Filters are indicated for patients with acute PE who have an active bleed (making blood thinners unsafe) or those who develop recurrent PEs despite adequate anticoagulation. Retrievable filters are preferred and are meant to be removed once the bleeding risk resolves and blood thinners can be started.
Patients with massive PE often require intensive care support to maintain organ perfusion.
ECMO (Extracorporeal Membrane Oxygenation): In the most extreme cases of cardiac or respiratory collapse, VA-ECMO can provide temporary heart and lung support, acting as a bridge to surgical embolectomy or recovery.
How long you need to take blood thinners depends on what caused the pulmonary embolism.
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CT scans use X-rays to create detailed cross-sectional images and are excellent for visualizing kidney stones, detecting tumors, and evaluating traumatic injuries. They are fast and widely available. MRI uses strong magnetic fields and radio waves to produce detailed images of soft tissues, making it superior for staging prostate cancer, evaluating bladder wall invasion, and assessing pelvic floor disorders without ionizing radiation.
Contrast dye, usually iodine-based, is injected into a vein to highlight the blood vessels and urinary tract organs. As the kidneys filter the dye from the blood, it opacifies the urine. This allows the radiologist to see the internal structure of the kidneys, the ureters, and the bladder clearly, revealing blockages, tumors, or structural abnormalities that would be invisible on a non-contrast scan.
Multiparametric MRI is an advanced imaging technique that combines standard anatomical sequences with functional sequences like Diffusion-Weighted Imaging and Dynamic Contrast-Enhanced imaging. This provides a comprehensive assessment of the prostate, allowing doctors to distinguish between benign conditions like BPH and significant prostate cancer, and to guide targeted biopsies.
CT scans do involve exposure to ionizing radiation, which carries a small theoretical risk of cellular damage over time. However, modern CT scanners use dose-modulation technology to minimize this exposure to the lowest level necessary for a diagnostic image. The benefit of an accurate and timely diagnosis for serious urological conditions typically far outweighs the minimal risk of radiation.
Many modern orthopedic implants are MRI-safe, although they may cause some image distortion. However, older pacemakers, defibrillators, and certain metal clips may be unsafe in the strong magnetic field. It is critical to inform the imaging team of any metallic implants so they can verify their safety compatibility or recommend an alternative test like a CT scan.
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